Breaking_News_Archiv.. - The Lung Center

Breaking News ArchivesThe Lung CenterRifampin May Be Better Tolerated Than Isoniazid for LatentTuberculosisAs per the results of a multicenter, randomized trial reported in theNovember 18 issue of the Annals of Internal Medicine treatment oflatent tuberculosis with 4 months of rifampin was associated withfewer serious adverse events and better adherence than 9 months ofisoniazid.Ann Intern Med. 2008;149:689–697, 761–763Probiotic May Help Prevent Ventilator-Associated PneumoniaAs per a pilot study published in Critical care journal, prophylaxisagainst ventilator-associated pneumonia, the probiotic bacteriumLactobacillus plantarum 299 (Lp299) is as effective as the antisepticchlorhexidine in reducing the pathogenic bacterial load in theoropharynx of tracheally intubated, mechanically ventilated, criticallyill patients.Crit Care 2008Outcomes Poor for Extensively Drug-Resistant TuberculosisAccording to the results of a study published in the November issue of AmericanJournal of Respiratory & Critical Care Medicine,extensively drug-resistanttuberculosis (TB) predicted poor treatment outcomes and long-term mortality inpatients with multidrug-resistant tuberculosis (MDR-TB).Am J Respir Crit Care Med. 2008;178:1000–1001, 1075–1082Surfactant Therapy Improves Survival of ARDS Patients Only inSome Severe CasesAccording to a study in the October issue of Chest, surfactantreplacement therapy does not appear to generally improve survivalin patients with acute respiratory distress syndrome (ARDS),

although it does significantly reduce mortality in patients with severeARDS caused by pneumonia or aspiration..Chest 2008;134:724-732.Endothelial Dysfunction Seen in "Minimally Symptomatic"Obstructive Sleep ApneaA small cross-sectional study in AJRCCM suggests that Obstructive sleep apnea(OSA) can impair vascular endothelial function even if it isn't associated withdaytime sleepiness, also in "minimally symptomatic" patients, no evidence for anOSA effect on blood pressureAm J Respir Crit Care Med. 2008;178:984-988Beta-Agonists for Asthma up Cardiac Event Risk in PatientsWith Long-QT SyndromeAccording to results of a study published in the October 1st issue ofthe American Journal of Cardiology, Patients with the long-QTsyndrome and asthma who are treated with inhaled beta-2 agonistshave an increased risk for cardiac events. This risk is diminished inthose receiving beta-blockers.Am J Cardiol 2008;102:871-874Statins Appear to Prevent VTE in Hospitalized Cancer PatientsAccording to research presented at CHEST 2008, the American College of ChestPhysicians 74th Annual Scientific Assembly, patients hospitalized with solidtumors who are also on statin therapy have a significantly lower risk for venousthromboembolism (VTE) than those not taking the lipid-lowering agents.Statin Use Reduces Mortality After Hospitalization forPneumoniaA study in the October 27, 2008, issue of the Archives of InternalMedicine, adds to the accumulating evidence that statin use isassociated with improved prognosis after severe infections.Priorstudies investigating the benefits of statin therapy in patients withpneumonia have had conflicting results. There are several biological

mechanisms, however, including the ability of statins to modify thehumoral response, to suggest that the drugs might be beneficial inthis setting. Other clinical and experimental studies have shown thatthe lipid-lowering agents improved outcomes after severeinfections.Given the availability of statins, with their relatively lowcost and mild adverse effects, positive results of statin-therapy trialsin patients with pneumonia would have substantial clinical andpublic-health implications.Arch Intern Med. 2008;168:2081-2087.Depression May Exacerbate COPD Symptoms, IncreaseHospitalizationsStudy published in the November 1 issue of the American Journal ofRespiratory and Critical Care Medicine suggests that depressionmight actually worsen symptoms and increase hospitalization ratesin patients with chronic obstructive pulmonary disease(COPD).Although depression is a common comorbidity in COPD, thisis the first study to report a possible causal relation betweendepressive symptoms and worsening COPD and subsequenthospitalization in patients with stable disease.Am J Respir Crit Care Med. 2008;178:913-920.Chest CT Recommended for Detecting Lung Metastasis inHead and Neck CancerThe October issue of the Archives of Otolaryngology–Head & NeckSurgery reports that computed tomography (CT) scanning is highlyaccurate in detecting pulmonary metastases that occur in patientswith head and neck squamous cell carcinoma, and should beperiodically performed in high-risk patients.Arch Otolaryngol Head Neck Surg. 2008;134:1050-1054Sildenafil May Enhance Epoprostenol Therapy for PulmonaryArterial HypertensionAccording to the report in the Annals of Internal Medicine forOctober 21, adding sildenafil to epoprostenol for treatment ofPAH can enhance exercise capacity, hemodynamic parameters,quality of life, and time to clinical worsening. Sildenafil use does not,however, improve the Borg dyspnea score.Alone, both drugs havebeen shown to be useful treatments for PAH. Since each drug has a

different mechanism, there could be a synergistic effect when usingboth.Ann Intern Med 2008;149:521-530.NSCLC in Never-Smokers a Separate Disease From NSCLC inSmokersAs per a study published in Sept issue of Cancer, survival rates are better for non-small cell lungcancer (NSCLC) patients who were never-smokers than in NSCLC patients with a history of smoking.Other disease characteristics are different as well between the two populations.Cancer 2008;113:1012-1018Third-Generation Chemotherapy for Advanced NSCLC Linked toBetter SurvivalA study published in the October issue of Thorax suggests an association between utilization ofthird-generation chemotherapy and slightly increased survival of patients with advanced non-smallcell lung cancer (NSCLC).Thorax 2008;63:866-871.Procalcitonin Levels May Help Guide Antibiotic Use for AcuteRespiratory Tract InfectionsProcalcitonin-guided therapy reduces antibiotic use for acute respiratory tract infections in primarycare, according to the results of a randomized study reported in the October 13 issue of the Archivesof Internal MedicineArch Intern Med. 2008;168:2000-2007, 2007-2008Procalcitonin May Help Detect Serious Bacterial Infections in FebrileInfantsUse of procalcitonin was effective in detecting serious bacterial infections (SBIs) in young febrileinfants according to the results of a prospective, observational study reported in the October issueof Pediatrics.Pediatrics. 2008;122:701-710Using Guideline Definition Leads to COPD OverdiagnosisThe definition of airflow obstruction ( FEV1 to FVC ratio < 0.70 regardless of gender and age) usedby most clinical guidelines may lead to substantial overdiagnosis of COPD in older patients seen inprimary care settings, according to a report in the October issue of European Respiratory Journal.Eur Respir J 2008;32:945-952

BNP Level Linked to Poor Outcomes in Pulmonary Embolism PatientsElevated levels of brain-type natriuretic peptide (BNP) or N-terminal-pro-BNP (NT-pro-BNP) aremarkers for risk of in-hospital complications and death in patients with acute pulmonary embolism,according to a report in the American Journal of Respiratory and Critical Care Medicine.Am J Respir Crit Care Med 2008;178:425-430.Obesity Linked to Reduced Steroid Response in AsthmaticsThe cellular response to dexamethasone is reduced in overweight/obese patients with asthmarelative to their lean counterparts, as reported in the first October issue of the American Journal ofRespiratory and Critical Care Medicine.Am J Respir Crit Care Med 2008;178:682-687.Inhaled Anticholinergics for COPD Raise CV Event Risk in Meta-AnalysisPatients with chronic obstructive pulmonary disease (COPD) who used inhaled anticholinergicagents for at least a month, compared with controls who took placebo or other inhaled agents,showed a significant 58% independent increase in risk of cardiovascular (CV) death, myocardialinfarction (MI), or stroke in a 17-trial meta-analysis appearing in the September 24, 2008, issue of theJournal of the American Medical Association [1]. Their risk of CV death alone jumped 80%, althoughsuch events were few in the populations studied. Most of the excess risk appeared to come fromstudies in which the drugs, ipratropium bromide (and tiotropium bromide, were taken for at least sixmonthsJAMA. 2008;300:1439-1450Patients With Rheumatoid Arthritis at Increased Risk of Lung CancerThe risk of lung cancer is increased in patients with rheumatoid arthritis, even after taking intoaccount the effects of tobacco and asbestos exposure, according to a case-control study in USmilitary veterans.J Rheumatol 2008;35:1695-1696,1704-1708.Interferon Gamma Assay Useful for Diagnosis of Latent Tuberculosisin ChildrenInterferon gamma assays can replace tuberculin skin tests for diagnosing latent tuberculosis inchildren, and particularly in those in whom skin tests results are confounded by previousvaccinations or infections,The interferon gamma assay will be particularly beneficial among childrenwith false positive TST, as it not influenced by the confounding effects of BCG and non-tuberculosis

mycobacteria,enabling us to estimate the annual risk of infection...and to make clinical diagnoses ofpediatric tuberculosis in the developing world as well as in industrialized countriesEpidemiol Infect 2008;136:1179-1187Rhinitis Linked to Adult-Onset AsthmaBoth allergic and nonallergic rhinitis predict adult-onset asthma, according to the results of alongitudinal, population-based study reported in the September 20 issue of The Lancet.The 8.8-yearcumulative incidence of new-onset asthma for no atopy (control), atopy only, nonallergic rhinitis,and allergic rhinitis are 1.1%, 1.9%, 3.1%, and 4.0%, respectively. The risk for asthma is increasedwith both allergic and nonallergic rhinitis but is stronger for allergic rhinitis, especially in patientswith sensitization to 3 or more inhaled allergens.Lancet. 2008;372:1012-1014, 1049-1057.Proton Pump Inhibitor Use Linked to Risk for Community-AcquiredPneumoniaUse of a proton pump inhibitor (PPI) started within the past 14 days increased the risk forcommunity-acquired pneumonia, but long-term use did not increase that risk, according to theresults of a nested case-control study reported in the September 16 issue of the Annals of InternalMedicineAnn Intern Med. 2008;149:391-398.Poor Asthma Control During Pregnancy May Lead to Preterm BirthWomen with inadequately treated asthma during pregnancy are at increased risk for prematuredelivery, according to findings by the Organization of Teratology Information Specialists (OTIS)Collaborative Research Group.Medications to treat asthma are often restricted during pregnancy outof concern for potential harm to the fetus, even though there is evidence that severe asthma mayaffect perinatal outcomes, lead author Dr. Ludmila N. Bakhireva and her associates note in theAugust issue of the Annals of Allergy, Asthma and ImmunolAnn Allergy Asthma Immunol 2008;101:137-143.